Zika virus infection epidemiology and demographics

Zika as global threat

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Luke Rusowicz-Orazem, B.S.; Serge Korjian M.D.; Yamuna Kondapally, M.B.B.S[2]; Tarek Nafee, M.D. [3]

Overview

In 2015, Zika virus infection outbreaks rose dramatically, particularly in Brazil as observed by the manifestation of a correlated complication, microcephaly, in infants born to mothers with Zika virus infection, an incidence of approximately 100 per 100,000 infants. The majority of Zika virus infection cases are reported in South Africa and Tropical Asia. As of 2014, Zika Virus infection outbreaks have also become more common in South America. Cases reported in other regions of the world are attributed to travel from areas with outbreaks. Zika virus infection affects all age groups, with newborn infants particularly vulnerable due to risk of transmission from the mothers upon birth.

Epidemiology

• As only 1 in 5 people with Zika virus usually becomes symptomatic, and given that the symptoms are generally mild, it is hard to establish a clear incidence of the infection.
• The incidence of Zika virus infection is often correlated to the one of its circumstantially associated complications: microcephaly
• Based on this method, the incidence of Zika virus infection in increasing.
• As of November 2015, it is estimated that 99.7/100,000 live births of infants displaying microcephaly could be attributed to Zika virus.
• This is a twentyfold increase from 2010's report of 5.7/100,000 cases.

Worldwide Distribution

• According to Pan American Health Organisation (WHO regional office for Americas), 46 countries and territories have confirmed indigenous vector-borne transmission of Zika virus in the region of Americas since 2015(most recent update September 8, 2016).
• Five countries in the Americas reported sexually transmitted Zika cases.

• Argentina
• Canada
• Chile
• Peru
• The United States of America

• The British Virgin Islands have also confirmed vector borne autochthonous transmission of Zika virus.

North America

• Mexico: Showing downward trend on number of confirmed cases.
• United States of America: Zika transmission continues to expand.

• Florida: Three counties in the Florida has confirmed autochthonous cases of Zika Virus infection.
  • Miami Dade
  • Palm Beach
  • Pinellas

Central America

• Central America has decreasing cases of trend of cases except in Costa Rica, where there has been increasing trend of cases since the beginning of outbreak.
• Between late 2015 and early 2016, there was greatest increase in Zika cases in Central America.

Caribbean

• The Caribbean countries are showing decreasing trends.

South America

• All countries of South America are showing decreasing trends.

Singapore

• According to the Centers for Disease Control and Prevention (CDC), the first local transmission of Zika virus infection (Zika) was reported in Singapore in August 2016.

United States

• There have been cases of local level transmission in the continental United States.
• Upto August 17, 2016, 8,000 locally-acquired cases have been reported in U.S. territories.
• 2,245 travel associated cases have been reported in the United States.

CDC general guidance on Zika Virus:

• Pregnant women and their sex partners who are concerned about potential exposure to Zika virus may consider postponing non essential travel to all parts of Miami-Dade county.
• All pregnant women should be assessed for possible Zika virus exposure and signs or symptoms of Zika during each prenatal visit.
• Women with Zika should wait at least 8 weeks after symptoms start before trying to get pregnant.
• Men with Zika should wait at least 6 months after symptoms start before couples try to get pregnant.
• Pregnant women with possible Zika exposure and signs or symptoms of Zika should be tested for Zika.
• Effective contraception to prevent pregnancy in women and their partners who want to delay or prevent pregnancy is a key prevention strategy for Zika.

Travel Associated cases of ZIKV

†Data based on CDC (2016). Figure owned by WikiDoc - must be redistributed!

Locally Acquired cases of ZIKV

Locally acquired cases of ZIKV infection

State or Territory	Number of Cases
Puerto Rico	25,355
U.S Virgin Islands	469
Florida	128
American Samoa	47

• Laboratory-confirmed Zika virus disease cases reported to ArboNET by state or territory (as of September 14, 2016).

South Florida

Updated guidance for Wynwood area and Miami-Dade County (red area on map below):

• Pregnant women and partners of pregnant women who are worried about potential exposure to Zika may consider postponing nonessential travel to all parts of Miami-Dade County, including the Wynwood area.
• Pregnant women and partners of pregnant women living in or traveling to the area should strictly follow steps to prevent mosquito bites.
• Women and men living in or who traveled to the area should be aware that the location was considered to have active Zika virus transmission from June 15 to September 18, 2016. Pregnant women should talk to their doctor or other healthcare provider about getting tested for Zika. Partners of pregnant women should consistently and correctly use condoms to prevent passing Zika during sex, or they should not have sex during the pregnancy.
• Women and men who do not have signs or symptoms of Zika and who traveled to the area from June 15 to September 18 should wait at least 8 weeks before trying to get pregnant.
• Men who had signs or symptoms of Zika or were diagnosed with Zika and who traveled to the area from June 15 to September 18 should wait at least 6 months before trying to get their partner pregnant.

Updated guidance for Miami Beach area:

• Pregnant women should not travel to the Miami Beach area.
• Pregnant women and partners of pregnant women living in or traveling to this area should strictly follow steps to prevent mosquito bites.
• Women and men who live in or traveled to this area and who have a pregnant sex partner should use condoms to prevent infection every time they have sex or not have sex during the pregnancy.
• Pregnant women who live in or frequently travel to this area should be tested in the first and second trimester of pregnancy.
• Pregnant women who traveled to or had unprotected sex with a partner that traveled to or lives in this area should talk to their healthcare provider and should be tested for Zika.
• Women and men who live in or frequently travel to this area should talk to their healthcare provider about plans for pregnancy.
• Women and men who traveled to this area should wait at least 8 weeks before trying to get pregnant.

Demographics

Age

• Zika virus infection may affect individuals of all age groups.

Gender

• Men and women are equally affected by Zika virus infection.